The National Committee for Quality Assurance (NCQA), the American Academy of Family Physicians National Research Network (AAFP NRN), and New York City Department of Health and Mental Hygiene have joined in this proposal to address critical policy questions regarding the feasibility, clinical acceptance, and measurability of MU Stage 3 objectives. Our long-term goal is to demonstrate how meaningful use of health IT can contribute to achievement of the National Quality Strategy goals of better care, healthy people and communities, and affordable care. This project will examine the feasibility, measurability and clinical relevance of six proposed MU Stage 3 objectives related to care coordination, including reconciliation and tracking of referrals, care transition record, and use of information for patient engagement and clinical decision-making. Our specific aims are Aim 1 To assess the technical feasibility and clinical acceptance of the proposed MU Stage 3 objectives for care coordination in diverse practice settings, Aim 2 to identify organizational and contextual factors that distinguish practices with a higher versus lower level of implementation of EHR functionality and clinical workflows for care coordination envisioned by the proposed MU Stage 3 objectives, and Aim 3 to explore methods for measuring and reporting on implementation of the proposed MU Stage 3 Objectives. This mixed-methods study will include a survey of 300 diverse practices to understand current implementation of care coordination activities in EHR functionality and clinical workflows, interviews of 20 practices that have implemented care coordination workflows with and without EHR functionality, and case studies of 10 practices that have adopted health IT capabilities for aspects of care coordination that are relevant to with the proposed objectives. We will vet the results and technical recommendations through review with a panel of EHR vendors. We will use the results of this project to provide our federal government a roadmap to achievement of the proposed MU objectives and how to measure their achievement by providers in ambulatory care settings. At the end of this 12-month project, we will have developed and disseminated 1) recommendations for potential revisions to the proposed MU Stage 3 objectives and to the proposed measures, 2) recommendations for changes in EHR certification criteria, and 3) examples of successful workflows and information on barriers to implementation. In addition to a report for federal policymakers, we will develop dissemination materials appropriate for primary care and specialty practices and disseminate these widely through NCQA's educational programs for providers and health plans, through AAFP educational channels, and in collaboration with AHRQ.